2015 State Legislative Conference

Family Physicians Can Lead Fight Against Opioid Abuse, Say Speakers

Prescriptions may be written to relieve pain or heal wounds, but as family physicians are uncomfortably aware, some patients turn them to a different purpose -- one that can be fatal.

Robert Rich, M.D., a family physician in Elizabethtown, N.C., and chair of the AAFP Commission on Health of the Public and Science, says during the AAFP State Legislative Conference that physicians need to take a leadership role regarding opioid abuse.

Each year, 17,000 people die from opioid abuse. The problem has grown exponentially since 1999, when 4,000 opioid-related deaths were reported.

Speakers at the AAFP State Legislative Conference, held here Nov. 6-7, discussed the problem, how physicians can respond to it and what some states are doing to counter associated mortality rates.

Daniel Blaney-Koen, J.D., senior legislative attorney with the AMA Advocacy Resource Center, noted some correlation between prescription rates and opioid mortality rates, but he said there is not always a clear connection. For instance, Washington, Colorado and Florida have low prescription rates but a large number of deaths from opioid abuse.

Heroin use is increasing across all demographics, with 517,000 Americans addicted to the drug. Four out of five heroin users started with an opioid prescription. Given this connection, Blaney-Koen said, physicians and state officials need to ask whether dependence on opioids leads patients to seek "a greater high" from heroin after treatment ends.

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Speakers at the AAFP State Legislative Conference discussed what physicians can do to mitigate opioid abuse and actions some states are taking to counter associated mortality rates.

Each year, 17,000 people die from opioid abuse -- an exponential jump from the 4,000 deaths seen in 1999.

Some state efforts to address the problem, however, could be viewed as too restrictive, such as involuntarily committing those who exhibit abusive behavior.

He warned about the prevalence of "doctor-shopping" patients who seek more prescriptions than they need from multiple physicians. Some physicians who see the ruse worry immediately about liability.

"When a physician sees a patient who is doctor-shopping, they often discharge the patient," Blaney-Koen said. "The physician will say, 'I don't want to get a call from the medical board asking me why I prescribed medication for the patient.'"

Physicians may, however, want to consider that such patients could very well need care coordination to get a potential addiction under control and prevent it from becoming worse, he suggested.

Blaney-Koen also touched on state measures intended to reverse the rate of addiction that might be too restrictive. The Massachusetts governor, for instance, has proposed a 72-hour "involuntary commitment" of patients who show signs of addiction. Tennessee officials proposed a two-year limitation on medication therapy, and mothers of newborns there can be jailed if their babies show signs of withdrawal and they are not seeking treatment.

"The threat of jail time is not the best way to promote prenatal care," Blaney-Koen observed.

And although 49 states have a prescription drug monitoring program, they collect different data, and only half of the state systems communicate with each other.

Some state efforts have helped reduce the rate of abuse, including in Florida, where physicians can no longer dispense medication from their offices. Other initiatives also were cited as helpful to stemming addiction. Thirty-seven states have expanded access to naloxone, and 34 states have Good Samaritan laws in place to protect individuals without medical training who assist victims of addiction.

Robert Rich, M.D., a family physician in Elizabethtown, N.C., and chair of the AAFP Commission on Health of the Public and Science, urged physicians to take a leadership role in preventing and managing opioid abuse so that state regulations do not become overly restrictive.

He said, for instance, that physicians should press states to recognize buprenorphine as an addiction treatment for pregnant women, even though obtaining authorization to use it may take considerable time.

And he pointed out that some solutions can be simple. Each day, an estimated 2,500 children abuse opioids for the first time. They get the drugs primarily through an easily accessible source, such as a parent's medicine cabinet. A tactic that can prevent that, Rich said, is a lockbox to store the opioids out of children's reach.